Because we know your time and money are both valuable, First Tennessee has developed
an exclusive home loan offer for medical professionals that simplifies the mortgage process
and allows you to finance up to 100% of your home’s value. Take advantage of our low
competitive rates, and move into your dream home or refinance your current one.
Contact a Relationship Manager to learn more about our low rates.
Ken Reece
Senior Vice President
ph: 919-789-2981
email: kgreece@ftb.com

Do you have young patients who could benefit from a fitness program where children and
teens can participate under the direction of degreed and certified trainers, in addition to
nutritional guidance and support from licensed dietitians and physicians.
This 12 week program, offered through HealthQuest Fitness & Wellness Center, includes
an initial orientation/assessment, 36 group exercise sessions with a Personal Trainer, 3 group
nutritional education sessions with a Dietitian, a post assessment and graduation certificate!
This Program is tailored to yield the following benefits for youth:

nine babies born (11.5 percent) is delivered before 37 completed weeks of gestation,
according to the Society for Maternal-Fetal Medicine. Pre-term births are a major cause of
infant mortality, and reducing both starts with preventing pregnancy complications, such
as preterm labor, preeclampsia and placental dysfunction.

In this region, WakeMed Health & Hospitals Maternal-Fetal Medicine’s recent expansion
of services for high-risk patients will give many newborns a healthier start. This month’s
cover story gives an overview of the advances within WakeMed Physician PracticesMaternal-Fetal Medicine that include the addition of new physicians and a genetic
counselor. It also is opening a new office in north Raleigh this month.

You can bolster your marketing efforts with a presence in The Triangle Physician. Each

Every precaution is taken to insure the accuracy
of the articles published. The Triangle Physician
can not be held responsible for the opinions
expressed or facts supplied by its authors.

issue reaches more than 6,000 within the Triangle medical community, and that means
your ads, news articles and cover stories will too.

Now’s the time to plan your marketing mix for a strong and healthy start for 2015.
For more information on opportunities ahead, please send an e-mail to: heidi@
trianglephysician.com.

With great appreciation for all you do,

Heidi Ketler
Editor

4

The Triangle Physician

Opinions expressed or facts supplied by its
authors are not the responsibility of The
Triangle Physician. The Triangle Physician makes
no warrant to the accuracy or reliability of this
information.
All advertiser and manufacturer supplied
photography will receive no compensation for
the use of submitted photography.
Any copyrights are waived by the advertiser.
No part of this publication can be reproduced
or transmitted in any form or by any means
without the written permission from The
Triangle Physician.

From Preconception Through Delivery
WakeMed Expands Its Fully Comprehensive,
High-Risk Prenatal Care Program in Wake
County to Keep Patients Close to Home
The WakeMed Health & Hospitals Mater-

Avenue. In October, they will expand their

F.A.C.O.G., director of WakeMed’s Mater-

nal-Fetal Medicine division is expanding

presence with an additional office on

nal-Fetal Medicine program. “WakeMed’s

threefold, with new specialists, an addi-

the WakeMed North Campus – the site of

expanded division and practice mean

tional practice location and more specialty

WakeMed’s future women’s hospital. This

more women who need highly specialized

services for high-risk expectant mothers.

expansion and addition of services truly

maternal-fetal medicine services, such as

WakeMed’s practice, known as WakeMed

solidifies WakeMed’s ability to provide full-

genetic counseling, chorionic villus sam-

Physician Practices – Maternal-Fetal Medi-

service, comprehensive care for the high-

pling (CVS), intrauterine transfusion and

cine (WPP-MFM), now consists of three

risk mother from preconception through

advanced treatments for cervical insuffi-

maternal-fetal medicine physician special-

delivery in Wake County.

ciency, can stay close to home.”

“Raleigh is the capital city of North Caro-

The Maternal-Fetal Medicine team at

lina, yet for decades, we have had to

WakeMed collaborates with both private-

Their current practice location is on the

send many high-risk mothers outside of

practice obstetricians to care for patients

WakeMed Raleigh Campus on New Bern

Wake County,” said Avick G. Mitra, M.D.,

who need maternal-fetal consultation during

ists, an experienced genetic counselor and
several sonographers.

their pregnancy, as well as WakeMed’s inpatient obstetrics and gynecology physicians
for patients who may need hospitalization
prior to delivery for high-risk conditions.
“Our focus is always to work with the patient and her physician to optimize results
and ensure a healthy delivery of the baby,”
added Dr. Mitra. “With the addition of our
new physicians and genetic counselor, we
can now truly offer a comprehensive prenatal diagnosis and treatment program for
high-risk patients. And with the opening of
our new office in north Raleigh this October, we hope to be even more accessible
Utilizing 3-D sonography, Dr. Avick Mitra and sonographer Lisa Damiano demonstrate the normal facial
anatomy of a baby in the early second trimester of pregnancy.

6

The Triangle Physician

to the patients and families who need our
care.”

A Highly Skilled, Collaborative Team
Dr. Mitra has recently been joined by Carmen Beamon, M.D., M.P.H.; Jacqueline
Muhammad, M.D., and genetic counselor
Cheryl Dickerson, M.S., C.G.C. Each brings
a unique skill set and specific clinical interests that help enrich the range of offerings
the practice is now able to provide. The
team also includes a group of experienced
registered diagnostic medical sonographer
(RDMS)-certified sonographers who are
specially trained in high-risk obstetric ultrasound, including fetal echocardiography.
Avick Mitra, M.D., F.A.C.O.G.
With clinical interests in cervical insufficiency and prenatal diag-

Now offering genetic counseling, WakeMed Physician Practices – Maternal Fetal Medicine can address
women’s genetic or hereditary concerns either before conception or during pregnancy and assist patients
in determining which, if any screening/testing options fit their particular situation.

nosis, Dr. Mitra brings
more than 20 years of

cal degree and master’s degree in public

who have genetic risk

experience in caring

health from UNC-CH.

factors or who have
had an abnormal fetal

for women with highrisk pregnancy con-

Jacqueline Muhammad, M.D., F.A.C.O.G.

ultrasound. She works

ditions and their unborn children. Board

Dr. Muhammad’s clinical interests include

closely with patients

certified in obstetrics and gynecology as

infant prematurity, infant

who are experiencing a

well as maternal-fetal medicine, Dr. Mitra

mortality, fetal therapy

high-risk pregnancy, as well as individuals

earned his medical degree from Emory Uni-

and disparities in health

who desire pre- or post-pregnancy consul-

versity School of Medicine in Atlanta and

care. She is dedicated to

tation for genetic concerns or other issues

completed a residency in obstetrics and

improving perinatal out-

that may place a future pregnancy at higher

gynecology and a fellowship in maternal-

comes for underserved

risk for complications. She earned her mas-

fetal medicine at The University of North

women. Board certified in obstetrics and

ter’s degree in human genetics from the

Carolina at Chapel Hill (UNC-CH). Prior to

gynecology and in maternal-fetal medicine,

Medical College of Virginia in Richmond,

joining WakeMed, he spent 20 years with

Dr. Muhammad has an extensive background

Va., and is certified by the American Board

Carolinas Medical Center in Charlotte, N.C.,

in managing high-risk pregnancies. She com-

of Genetic Counseling. Ms. Dickerson’s ca-

where he served as the director of maternal-

pleted her maternal-fetal medicine fellowship

reer is distinguished by several past leader-

fetal medicine for 13 years and director for

at Thomas Jefferson University Hospital in

ship positions with the National Society of

the Center for Cervical Insufficiency.

Philadelphia after earning her medical de-

Genetic Counselors and the Accreditation

gree and completing her residency in ob-

Council for Genetic Counseling.

Carmen Beamon, M.D., F.A.C.O.G.

stetrics and gynecology at the University of

Also board certified in obstetrics and gyne-

Medicine and Dentistry of New Jersey (now

All of WakeMed’s Maternal-Fetal Medicine

cology, with diplomate

Rutgers) Robert Wood Johnson Medical

providers value the ability to work as a part-

status, Dr. Beamon has

School in New Brunswick, N.J.

ner in care, collaborating with the patient
and her already-established obstetrician

specific clinical interests in prenatal diag-

Dr. Muhammad, Dr. Mitra and Dr. Beamon

and/or specialist through the provision of

nosis and intervention,

are all members of The American College

genetic counseling, comprehensive prena-

preterm birth preven-

of Obstetricians and Gynecologists and the

tal diagnosis and testing, advanced thera-

Society for Maternal-Fetal Medicine.

pies and consultative recommendations.

medicine fellowship and a residency in ob-

Cheryl Dickerson, M.S., C.G.C.

“In the vast majority of cases, we provide

stetrics and gynecology at UNC-CH, where

Ms. Dickerson, the practice’s certified ge-

diagnostic and consultative services to a

she also served as the administrative chief

netic counselor, has more than 20 years of

patient’s doctor in order to determine the

resident. Dr. Beamon also earned her medi-

experience counseling pregnant women

best treatment options. We also provide

tion and management of high-risk maternal
conditions. She completed a maternal-fetal

october 2014

7

additional specialist care on an as-needed
basis and, if necessary, we help determine
the optimal time for a patient to deliver her
baby,” said Dr. Mitra. “Our intention is not to
assume responsibility for the entire antenatal care of the patient. Instead, we collaborate and consult with the patient’s physician
to help achieve the best possible outcome
for both mother and baby.”
Advanced Maternal-Fetal
Medicine Care
WakeMed’s Maternal-Fetal Medicine team
provides the highest level of prenatal care
by offering comprehensive prenatal diagnosis, surveillance and treatment.
For patients with an indication that may
increase the risk for a medical condition,
birth defect, chromosomal abnormality or
inherited condition, genetic counseling is

WakeMed North Women’s Hospital to Open May 2015
10000 Falls of Neuse Road, Raleigh
In May 2015, the WakeMed North campus will add
a 61-bed women’s hospital, providing state-of-the
art, world-class care for patients. WakeMed North
Hospital will be the first and only full-service women’s hospital in the area, providing a wide variety
of health services for women of every age.
A full range of obstetrics and gynecological services will range from general obstetrics to the most
sophisticated specialty care. In addition to the physicians, patient care will be supported around the
clock by a team of specialty trained obstetricians
and gynecologists – known as hospitalists – who
are experts in caring for women in a hospital environment.

ately adjacent to WakeMed North Women’s
The WakeMed practice also provides com-

Hospital, which is scheduled to open in

prehensive care for patients managing cer-

May 2015.

8

The Triangle Physician

For more information visit www.wakemed.org.

Marketing

Cultivating
Your Brand Online
By Wendy Coulter

In an increasingly digital world, your

number of calls or patients you get for

website often creates the first impression

every 100 visits to your website).

your patients will have of your business.

• Focus on the unique elements of your

A vital part of your reputation, your online

practice. Health care consumers today

site is ultimately an extension of your

have endless choices, so when building

brick-and-mortar practice, playing a major

your online presence, it’s important

role in whether or not customers want to

to differentiate yourself from your

do business with you. Every aspect of your

competitors.

site – from the words and images to site

• Provide strong content that is useful

functionality – contributes to the overall

and educational to your patients. Every

impression of your medical practice.

medical practice website should have a
frequently updated blog with seasonal

Here are a few tips for standing out from

health reminders, healthy lifestyle tips,

the competition:

preventive care information and other
resources.

• Website designs should be clean, crisp

• Tell your company story with video.

and well organized. Information should

Consumers

are

looking

for

your

be categorized into distinct topics,

services, and YouTube is the second-

and forms should be easy to find and

largest search engine in the world after

download. Slow sites with confusing

Google. Physician spotlights, health tips

navigation are big turnoffs, and most

or procedure videos are a great way to

people will waste no time moving on to

give potential patients a real-life glimpse
into your practice.

another site.
• Take the time to cultivate your brand

• Don’t

forget

about

social

media.

image and make sure all collateral

Facebook, LinkedIn, Google+, Twitter

– text, logos, images, photos, linked

and stylized e-newsletters are a vital

brochures, press release boilerplates,

part of your online presence as well as

etc. – have a clear and consistent

an effective way to communicate with

message.

and share your content with current

Wendy Coulter graduated from the School
of Design at North
Carolina State University with degrees
in architecture and
industrial design and
a minor in communications. She founded
Hummingbird Creative Group in 1995,
with a desire to put her ideas to work,
creatively solving problems for small
businesses. Hummingbird Creative Group
is an award-winning, full-service branding
agency that helps companies define brand
strategy, develop sustainable brand messaging and implement marketing tactics
through advertising, graphic design, sales
enablement, public relations and online
marketing services. Awards include “Pinnacle Business Award” from the Raleigh
Chamber of Commerce, as well as “Business of the Year,” “Employer of the Year”
and “Successful Achievement” awards
from the Cary Chamber of Commerce. Ms.
Coulter was named a “Top 50 Entrepreneur,” “Woman Extraordinaire,” “Mover
and Shaker” and “40 Under 40,” to name
a few. She is active in a variety of community and civic endeavors and frequently
presents on such topics as branding,
marketing, advertising and design.

• Let your potential patients get to know

and potential patients. Tip: Compelling

In short, today’s consumers increasingly

you. People want to know who they’re

headlines and beautiful images or

expect to be able to manage their lives

doing business with. Post high-quality

videos are the best way to capture

online, so be sure your medical website

photos of your team and well-written

attention on social media outlets.

makes a good impression and answers

bios that not only talk about medical

• Offer incentives: Placing offers on online

all the questions your patients may have

specialties and awards, but about

directories, such as CitySearch or Yelp,

about you. Your online content should of-

hobbies and personal interests.

is a great way to attract new patients and

fer potential patients concrete value and

give them a taste of your unique care

showcase how you are uniquely qualified

approach. This doesn’t need to be a

for the solutions they are searching for on

happy

discount, but more of an incentive, like

the web.

patients. Reviews from a third-party site

a free kit or low-priced preventive care

are most effective and can significantly

visit for self-pay patents.

• Include awards, curriculum vitae and
medical specialties.
• Include

testimonials

from

increase your conversion ratio (i.e., the

october 2014

9

Practice Management

Tips for Marketing
Your Practice
By Margie Satinsky – Special thanks to colleague Alice Saunders at Trisecta in Raleigh for her contributions to this article.

The options for marketing your practice

Tips for Marketing Effectively

are numerous. This article suggests tips

Direct your efforts to all segments

for marketing effectively and traps to

of your target market. You have

avoid.

the opportunity to market to different
groups, including existing patients and

Start at the Beginning

their influencers, potential new patients,

Let’s start with basics. Just what is

medical colleagues in other practices and

marketing? Marketing consultant Peter

your entire workforce.

Drucker calls marketing your “whole firm,
taken from the customer’s point of view.”

Existing patients comprise your captive

Taken one step further, marketing means

audience. Ease of making appointments,

“coordinated efforts to communicate with

clarity of instructions prior to a visit or

and persuade customers to purchase,

procedure, provision of a clear treatment

use and repurchase the services that

plan and caring follow-up all impact their

you provide through multiple points

perception of your practice.

of influence.” The American Medical
Association describes marketing as the

Pay close attention to marketing in your

process of planning and executing the

waiting area, thinking less about keeping

conception,

and

patients occupied than about educating

distribution of ideas, goods and services

them about the different services you

to create exchanges that satisfy individual

offer. For example, specialty practices

and organizational objectives.

that offer a mix of covered services

pricing,

promotion

and elective procedures have a good
Why Bother?

opportunity to inform patients about the

We count at least three good reasons

full range of offerings.

why you should market your practice.

Margie Satinsky is
president of Satinsky
Consulting L.L.C., a
Durham consulting
firm that specializes
in medical practice management.
She’s the author of numerous books
and articles, including Medical Practice
Management in the 21st Century.
For more information, visit
www.satinskyconsulting.com.
quire careful thought and time for feedback and revisions. Up-to-date, customized and easy-to-read information helps
build patient trust and facilitates referrals.
Track the ways in which patients find
you. Ask new patients how they heard
about you – e.g., recommendation of another patient, suggestion from an employee, physician recommendation, website.
Track the data by age, sex and zip code
and reassess your marketing strategy every six months. Make your hard-earned
dollars work for you.

First, medicine is competitive, like it or

Potential new patients and medical

not. You’re competing with others in your

colleagues will look carefully at your

specialty, as well as with large health care

website; make sure your message to each

systems. Second, decision-making about

group is clear and that you distinguish

medical care involves patients and those

yourself from competitors. With respect

who influence them (e.g., family, friends,

to your own workforce, if your employees

other health care providers). All need to

respect you and like the work atmosphere,

know what’s special about you. Third,

they’ll give you free positive publicity. If

patients and influencers make decisions

they’re disgruntled, they’ll share those

based not only on the perceived quality

feelings too.

particularly if they are integrated into

such as location, ease of parking, customer

Make print and online information

burdensome.

service, technology and reputation.

look professional. A professional look

of medical care, but also on other factors,

doesn’t need to be costly, but it does re-

10

The Triangle Physician

Regularly assess the experiences of
both patients and medical colleagues.
Patient perceptions of your scheduling
system,

office

comfort,

efficiency,

feedback of results and interaction with
employees may surprise you and your
workforce. You won’t know if you don’t
ask. Patient satisfaction surveys are great,
your practice operations and don’t feel

We like the approach of Avance Care,

a primary care practice with multiple

Broaden your goal from getting something

in recent years to curtail search engine

Triangle locations. It asks each patient

up fast to creating a website with sound

spamming techniques that historically al-

to stop briefly at a kiosk on the way out

information architecture, or in layperson’s

lowed vendors to manipulate rankings.

of the practice and answer a short list of

terms, “good bones.” Over time, you want

Clicks on a high-ranking link in Google

questions while the experience of the

to be able to deliver better functionality

may not translate to a conversion to a pa-

office visit is fresh. Ask medical colleagues

and expand content without redoing your

tient who enters your practice door. Use

as well as patients about their perceptions

initial efforts.

a search engine marketing professional
who has a good recent track record with

of dealing with you and your staff.
Looking and sounding like everyone

other practices, and ask those practices

Take a practical approach to social

else in your specialty. Forget about

how they know that their Google ranking

media. Use social media only in ways

trying to be all things to all people and

is driving new patient acquisition.

that directly, safely and cost-effectively

focus on your uniqueness. For example,

support your marketing objectives and

mention special fellowship training, the

Re-inventing the wheel in the develop-

communications needs. Just because a

frequency with which you perform a

ment of marketing materials and pa-

neighboring practice uses Twitter and

particular procedure, a new procedure in

tient communications. Take time at the

Facebook doesn’t make it right for you.

your community, the depth and warmth

beginning to create comprehensive and

Understand and manage the potential

of patient interaction and ease of making

understandable content about the subjects

risks before you begin, particularly with

an appointment. Ask patients and medical

that are important to you. Over time, refine,

respect to HIPAA privacy and security

colleagues for written permission to use

but don’t necessarily rewrite all that you

rule requirements.

their comments as testimonials.

have. Retain your primary source documents, so you can easily go back for more

Blogging can be useful for both marketing

Misunderstanding your Google rank-

and patient communication. For example,

ing. Google has made many changes

as you enhance what you do.

a primary care physician might start a
blog with brief tips for managing a chronic
condition. The effort has the potential to

what we call the potshot approach. A well-

55 Vilcom Center Drive
Boyd Hall, Suite 110
Chapel Hill, NC 27514

Drossman Gastroenterology PLLC
a patient-centered gastroenterology
practice focusing on patients with
difficult to diagnose and manage
functional GI and motility disorders.
The office is located within the
multidisciplinary health care center,
Chapel Hill Doctors. Dr. Douglas
Drossman is joined by physician’s
assistant, Kellie Bunn, PA-C.
Appointments are scheduled on Tuesday
and Wednesday and most laboratory
studies are available.

strategy may deliver better results. Who
do you want to reach and what message
do you want to deliver? Can you track the
effectiveness of what you are doing?
Saving a buck by hiring a relative to
do your website unless… that individual
is

experienced

in

developing

and

maintaining professional websites using
industry-standard

development

tools

and is committed to providing the timely
ongoing support that requires.

october 2014

11

Dermatology

Medical Sleuthing:

Differential Diagnoses
By Eric Challgren, M.D.

Even the simplest rash has the potential

ably analytical. When a patient comes to

for signaling a serious health issue. This is

me with something as common as acne,

why dermatologists are trained, day after

for example, I of course want to offer help-

day, case after case, in the art and science

ful treatment. But I am also intrigued by

of differential diagnosis. Ever alert, a der-

the cause of these skin conditions I see ev-

matologist inspecting potential skin can-

ery day. Is this simply teenage acne, or is

cer or something as common as atopic

there something else going on? Are heavy

dermatitis will have a half-dozen or more

cosmetics causing occlusive acne or is

diagnosis possibilities come to mind in

an athlete using anabolic steroids? These

rapid succession. You can almost hear a

causes and triggers will run through our

clicking noise in their heads as they check

heads as possibilities if the situation fits.

off the possibilities.

Eric Challgren
graduated from
North Carolina
State University
with a bachelor
of science degree
in chemical
engineering. He earned his medical
degree from the Medical College of
Ohio and completed his dermatology
internship at Medical College of Ohio
and residency at the Medical College of
Wisconsin.

Another example of a skin problem with
The thought process behind differential

multiple causes is eczema, which often

diagnosis works much like that of a detec-

improves as a child ages. Often, by late

tive. Using clues drawn from symptoms,

adolescence or early adulthood, it clears

medical tests, medical and family history

up entirely, although there’s a tendency

and a physical exam, a list is made of all

for the skin of these patients to continue

the possible diagnoses. Then, one by one,

to be sensitive and easily irritated. This

the list will be narrowed down by the clues

skin condition is typically red, blistering,

that don’t fit. This process of elimination is

itchy or oozing, and you can be sure that

called “differential diagnosis.” Ultimately,

high on the differential diagnosis list will

the outcome is an accurate diagnosis.

be the term “atopic dermatitis.”

There are, in fact, many paths to the

A thorough medical history involving ques-

same destination. In terms

tions about allergic diseases in the family,

of diagnosing illness,

problems, such as hay fever or asthma, al-

my pathway is

lergic reactions to foods, sleep problems,

invari-

questions on medications, recent illnesses,
immune status and much more will be un-

Dr. Challgren is a fellow of the
American Society for Mohs Surgery
and a member of the American Society
for Dermatologic Surgery, American
Society for Laser Medicine and Surgery,
American Academy of Dermatology,
American Medical Association, and
North Carolina Medical Association.
Areas of special interest include
Mohs surgery, pediatric dermatology,
dermatologic surgery, cosmetic
dermatology and skin cancer.
Dr. Challgren works at Southern
Dermatology & Skin Cancer Center
4201 Lake Boone Trail, Suite 200
Raleigh, NC 27607.

dertaken. But ultimately, it’s the process
of elimination that will play the big-

The art of seeing clearly what others may

gest part in coming up with

miss is a crucial factor in the life of a der-

the correct diagnoses.

matologist. In the case of skin cancer,
early detection can save a life. It takes a
very well-trained eye to diagnose quickly
and give the patient the greatest chance
for effective treatment. Luckily, these days
there are excellent treatment options, and
many chronic skin conditions can be wellmanaged, if not cured.

12

The Triangle Physician

Gasatroenterology

Understanding the Low

FODMAP Diet
By Kellie Bunn P.A.-C.

Patients with irritable bowel syndrome

leading to increased water content of

often describe food as a significant

the stool and associated complaints of

trigger for flares of their gastrointestinal

diarrhea.

symptoms. They often associate specific
food choices and alterations in stool

FODMAPs can be found in a variety of

frequency, consistency or abdominal pain.

common foods. The FODMAP family
includes:

These dietary changes are not typically

•F
ructose, which is found in many

completed in a systematic way that

fruits (apple, mango and pear) and

would allow for appropriate correlation

sweeteners.

of specific foods and symptoms. Thus
patients often find themselves confused
and frustrated as to what foods are “safe”
for them, and many patients unduly restrict

•F
ructans, which are found in wheat
and some vegetables (broccoli,
asparagus, cabbage and onions).
•L
actose, which is found in dairy

their diet excessively. They often look to

products, like milk and soft cheeses.

their providers for guidance in their quest

•G
alacto-oligosaccharides, which are

to determine their IBS “trigger” foods.

found in legumes.
•P
olyols, which are found in sweeteners

There has been little evidence to support

ending in “-ol,” such as sorbitol and

the use of dietary management for irritable

mannitol.

Kellie Bunn PA-C
graduated from the
University of North
Carolina at Chapel
Hill with a degree in
Biology before training
at the Duke University
Physician Assistant Program. She earned
a degree of Master of Health Sciences and
was inducted in Pi Alpha, the national
honor society for physician assistants.
She is currently a member of the American
Academy of Physician Assistants, North
Carolina Academy of Physician Assistants,
and the North Carolina Medical Society.
Kellie has worked with Dr. Douglas
Drossman at Drossman Gastroenterology
PLLC for over a year and is well trained
in the care of patients with functional GI
disorders.

The goal is to first eliminate all FODMAPS

bowel syndrome (IBS) symptoms until a

and

2014 article in Gastroenterology. This article

FODMAP foods can be added back into

discusses a controlled, cross-over study of

a low-FODMAP diet without triggering

patients with IBS who were placed on

then

determine

which

high-

symptoms. Providers may want to

a diet low in fermentable oligosac-

consider a referral to a dietician

charides, disaccharides, mono-

who specializes in this specific

saccharides and polyols (FOD-

diet.

MAPs). The study was able to

recommend a full FODMAP

The

dietician

may

show a statistically significant

elimination diet for two to four

reduction in their functional gas-

weeks, followed by a series of

trointestinal symptoms, including

food challenges. During these

bloating, pain and loose stool con-

challenges, the patient carefully

sistency with implementation of a low-

observes symptoms, as they reintroduce

FODMAP diet.

specific high-FODMAP foods.

FODMAP foods are poorly absorbed in

Getting started with a low-FODMAP diet

Resource

the small bowel and thus are fermented by

can be a difficult task for patients. Though

Emma P. Halmos, Victoria A. Power, Susan

bacteria. The fermentation produces gas,

the diet initially calls for avoidance of all

J. Shepherd, Peter R. Gibson, and Jane G.

which then provokes cramping and pain

high-FODMAP foods, some patients may

Muir; A Diet Low in FODMAPs Reduces

in IBS patients who are sensitive to luminal

tolerate some high-FODMAP foods without

Symptoms of Irritable Bowel Syndrome;

distension

experiencing associated symptoms.

Gastroenterology 2014;146:67–75

(visceral

hypersensitivity).

FODMAPs are also osmotically active,

october 2014

13

Women’s Health

Infertility:

Its Causes, Treatments and
Screening for Abnormalities
By Lindsay Wojciechowski

Bearing children is considered a rite of

Health-related issues can include hormon-

passage that is highly valued by cultures

al imbalances, sexually transmitted infec-

all over the world, and as a result, not be-

tions, chronic disease, etc.

ing able to bear children can cause significant stress both in individuals and on

Lifestyle factors like smoking, obesity,

relationships. Paradoxically, most couples

excessive weight loss, aging, stress, use

take their fertility for granted. Many are sur-

of anabolic steroids and other drugs may

prised when infertility is recognized, while

cause infertility.

in reality, one couple in six has a problem

Lindsay A.
Wojciechowski is a
nurse practitioner
and consultant to the
Women’s Wellness
Clinic and the Carolina
Women’s Research
and Wellness Center (CWRWC). She has
worked as a clinical nurse practitioner
for Triangle Family Practice at Duke
University Medical Center since 2006.
She also has taught courses at the
Duke University School of Nursing. Ms.
Wojciechowski’s focus is on women’s
health and family medicine, and she also
is the lead medical writer for the Women’s
Wellness Clinic.

that requires assistance. Navigating the op-

However, all attempts to categorize these

timal path of diagnostic testing and treat-

issues are somewhat artificial due to the

ments for a couple requires a highly per-

overlap and interrelationships that exist

sonal and individualized approach.

between them.

Causes of Infertility

Fertility Treatments

Infertility is defined as not being able to

The most comprehensive fertility treatment

conceive after one year of unprotected

is in vitro fertilization – also known as IVF.

sex. However, all humans are relatively

IVF essentially fixes every problem that we

sperm either by culturing sperm and

inefficient at reproduction and figuring

know how to fix by controlling the meeting

eggs together or by inserting one sperm

out if and where a problem exists can be

of the sperm and the eggs and early

into each mature egg through a process

challenging. It is relatively common for

embryo development, as well as ensuring

called intracytoplasmic sperm injection

both men and women to have issues that

that the embryos get into the uterine cavity

(ICSI). The fertilized eggs are then kept

lower the probability of becoming parents.

where they can implant.

in an incubator for three to six days before transfer. Culturing to the expanded

One way to categorize some of these issues

IVF is a five-step process, briefly outlined as:

blastocyst stage on Day 5 or Day 6 in-

is to think of them in terms of anatomy,

1. Ovulation induction: Prior to IVF, the

creases pregnancy rates, because many

woman takes a series of medications

human embryos arrest at an important

that are designed to stimulate the

stage of development, called gene acti-

environment, health and lifestyle.

vation that occurs on culture Day 4.

Examples of the physical issues associated

recruitment of several healthy eggs.

with fertility on the macroscopic level are

Because sperm, eggs and early embryos

4. Embryo transfer: After five to six days

blocked ducts (fallopian tubes in women

can make mistakes in cell division,

in culture, the fertilized eggs are placed

and vas deferens in men), ovarian cysts,

starting with more than one egg and

into the womb or vitrified (frozen) for

uterine fibroids, etc. On the microscopic

embryo increases the probability of

later transfer.

level, there can be problems with sperm,

success.

eggs, genetics, etc.

2. E
gg retrieval: Once a cohort of mature

Screening for Genetic

eggs develops, the woman is sedated

Abnormalities in Embryos

Environmental causes of infertility may

with intravenous medications and her

Not all embryos that develop to the

include rare exposures to environmental

eggs are harvested through a brief

expanded blastocyst stage of development

hazards, such as heavy metals or more

outpatient procedure.

will result in a positive pregnancy test.

commonly known exposures to medical

3. I nsemination and culture: An em-

One of the primary reasons for this is that

treatments that have known adverse

bryologist finds the mature eggs in the

eggs and early embryos frequently make

reproductive consequences.

harvested fluid and introduces them to

mistakes in cell division that are lethal.

14

The Triangle Physician

NEWSOURCE-JUN10:Heidi

8/5/10

12:57 PM

Page 1

These mistakes occur more frequently in
women as they age.
Error in embryo cell division can be

Do They Like
What They See?

detected through preimplantation genetic
screening (PGS). The blastocyst is an ideal
stage of development for doing genetic

Make sure you connect
with your key audiences
using strategic, cost-effective
advertising, marketing and public
relations.

testing, because the embryologist can
see the trophoblast cells (future placenta)
and the inner cell mass (future baby). A
small sample of the cells can be removed
from the future placenta knowing that the

Our services range from consultation,
to design, to creation and
implementation of strategic plans.

genetics of the placenta and the baby
should be the same.
Atlantic Reproductive Medicine Specialists,
a Raleigh-based fertility program founded
by Susannah Copland, M.D., and David
Walmer,

M.D.,

routinely

cultures

all

embryos to the expanded blastocyst stage

newsource
& Associates

of development and offers PGS screening.
Following the embryo biopsy, the biopsied
placental cells are shipped to an affiliated
genetic testing laboratory for analysis,

factors influence the increased accumulaIn the Duke analysis, the researchers first

tion of fat in the central body and increased

The National Heart, Lung, and Blood In-

pinpointed a strong correlation between par-

blood glucose levels in persons exposed to

stitute provided grant support (HL095987,

ticipants who reported high levels of chronic

high life stress and why there are also dif-

HL073389-01 and HL036587). Data were ob-

life stress factors and increased central obe-

ferences with ethnicity,” Dr. Hauser said.

tained from the National Institutes of Health

sity, as measured by hip circumference.

“This knowledge could help identify targets

database of Genotypes and Phenotypes.

for behavioral and drug interventions that
They then tested genetic variations across
the genome to see which ones, in combination with stress, seemed to have the biggest
influence on hip circumference. It turns
out that variations called single-nucleotide
polymorphisms (SNPs) in the EBF1 gene
showed a strong relationship with hip circumference, depending on levels of chronic psychosocial stress, according to a Duke
press advisory. What’s more, among those
with this particular genotype, hips grew
wider as stress levels increased.
“With further analysis, we found a significant
pathway from high chronic life stress to wide
hip circumference, to high blood glucose
and diabetes, to increased cardiovascular
disease, notably atherosclerosis,” said Abanish Singh, Ph.D., a researcher in computational biology at Duke and the study’s lead
author. “But we found this only in people
who were carriers of the EBF1 single-nucleotide polymorphism, and this was limited to
participants who were white.”
The researchers reproduced their findings
using data from another study, the Framingham Offspring Cohort.
“These findings suggest that a stress reduction intervention, along with diet and exercise, could reduce the risk of cardiovascular
disease and may be most effective in individuals with this specific genotype,” said
Redford Williams, M.D., one of the study’s
senior authors and director of Duke’s Behavioral Medicine Research Center.

Womens Wellness half vertical.indd 1

12/21/2009 4:29:23 PM

october 2014

17

UNC News

First-in-Kind Study Hopes to Fill
Knowledge Gaps about Sexual Assault
One in five women
in the United States
experience sexual
assault during their
lifetime, yet little is
known about the experiences and health
Samuel McLean,
outcomes of sexual
M.D., M.P.H.
assault survivors. A
new study seeks to change that.
The study is the first large-scale effort to
longitudinally evaluate health outcomes
after sexual assault. Nine hundred female
sexual assault survivors from around the
nation will be enrolled at the time that
they present for emergency care. Study
participants will then be followed for one
year and interviewed over time to better understand their physical and mental health during the recovery process,
as well as their experiences with law
enforcement, the legal system and the
medical system.
The study will be based at the University
of North Carolina School of Medicine.
Samuel McLean, M.D., M.P.H., director
of the TRYUMPH Research Program in
the UNC Department of Anesthesiology,

is the principal investigator of the study.
“There have been thousands of longitudinal studies of patient experiences and
health outcomes after other common
traumatic events, such as car accidents,
but no such studies of sexual assault
survivors have been performed,” Dr.
McLean said. “Our goal is to give sexual
assault survivors a voice and learn from
them about what is working with our legal and health care responses and what
isn’t.”
Another important goal of the study is
to learn about any physical symptoms
that develop after sexual assault. “It is
commonly understood that some women experience adverse psychological
outcomes, such as posttraumatic stress
disorder, after sexual assault,” said Dr.
McLean. “Evidence suggests that some
women also develop symptoms such as
fatigue and pain, but we know very little
about when or how this occurs. More
information about such outcomes is urgently needed.”
This type of information is important,
because while medical advances dur-

ing recent decades have revolutionized
the care of many trauma survivors, little
progress has been made in the types of
treatments available to survivors of sexual assault.
“A woman sexually assaulted in 1970
would receive risk stratification and
treatment to prevent sexually transmitted diseases and sexual assault,” said Dr.
McLean “More than 40 years later, the
types of preventive interventions that we
can offer haven’t changed. No treatments
are available to prevent other adverse
physical and mental health outcomes,
despite the fact that such outcomes appear to be common, may well be very
treatable or preventable.”
This study is being funded by a consortium of six National Institutes of Health institutes and centers: the National Institute
of Arthritis and Musculoskeletal and Skin
Diseases, the National Institute of Neurologic Diseases and Stroke, the National
Institute of Mental Health, the Office of
the NIH Director, the National Institute of
Nursing Research and the Eunice Kennedy Shriver National Institute of Child
Health and Human Development.

Award Is Nation’s Highest Honor for
Supporting Guard, Reserve Employees
UNC Health Care is one of 15 recipients
of the 2014 Secretary of Defense Employer Support Freedom Award, the highest
recognition given to employers for exceptional support of Guard and Reserve
employees.
UNC Health Care was selected for several
reasons, including:
• UNC Health Care employees volunteered to maintain a military couple’s

18

The Triangle Physician

house while both were deployed and
actively took on extra work responsibilities to support the service of their colleagues.
• The health system recognizes veteran
employees and actively recruits military
members and their spouses for employment.
• UNC Health Care is currently developing a master’s degree physician assistant (PA) program for veteran medics

to continue their medical careers after
leaving the military.
The plan to establish a PA master’s degree program at UNC Chapel Hill was announced in December 2012. Blue Cross
and Blue Shield of North Carolina and the
UNC School of Medicine, with input from
United States Army Special Forces Command, developed a plan for a program
that could provide a pathway for U.S.

UNC Research News
ognizing these 15 exceptional employers,
the Department of Defense celebrates the
contributions made by American employers to our ‘citizen warriors’. I commend
these extraordinary employers for their
unwavering commitment to service members and their families.”
The Freedom Award was instituted in 1996
under the auspices of Employer Support
of the Guard and Reserve (ESGR) to recognize exceptional support from the employer community. In the years since, 190
employers have been honored with the
award. To learn more about ESGR, visit
www.ESGR.mil.
From left, Defense Secretary Chuck Hagel, Timothy M. Weiner, M.D., and UNC Hospitals President Gary
Park meet at the Pentagon in Washington, D.C., with the Secretary of Defense Employer Support Freedom Award. (U.S. Army photo by Alfredo Barraza).

Army Special Forces medical sergeants
to translate the skills and expertise gained
through military service into a civilian career.
The new PA program assists military veterans while also helping to meet the growing need for highly trained health care
professionals in North Carolina.
“We are deeply honored to be selected
for this (Freedom) award,” said Timothy M. Weiner, M.D., a pediatric surgeon
at UNC Health Care and a Navy Reserve
Commander in 4th Medical Battalion,
Detachment 2. “As a member of the Navy
Reserve myself, I am very proud of the
support that UNC Health Care provides
to our many National Guard and Reserve
employees.”
This year’s Freedom Award recipients
were selected from 2,864 nominations
received from guardsmen and reservists
for going far beyond what the federal law
requires to support their military employees. The award is presented by Employer
Support of the Guard and Reserve, a Department of Defense office.
“Guardsmen and reservists across the nation rely on strong bonds with their civilian employers,” said Defense Secretary
Charles Timothy “Chuck” Hagel. “By rec

october 2014

19

WakeMed News

Three Leading Health Systems to Form
Company that will Share and Economize
Three health systems in North Carolina will
be working together to improve quality and
affordability for patients across the state.
Vidant Health in Greenville, Wake Forest Baptist Medical Center in WinstonSalem and WakeMed Health & Hospitals
in Raleigh are forming a shared services
operating company that will allow the organizations to gain benefits of scale while
maintaining current governance and independence. This relationship will not
include a merger or acquisition of organizations, according to a WakeMed press
advisory.
This unique relationship came about because the individual health care systems
share similar missions, visions, values
and strategic focus. Leaders from all three
systems “are confident success will come
from partnering with other like-minded
health care organizations to provide enhanced access and high quality, affordable
health care to patients and consumers,”
the advisory said.

This innovative model provides support for
health care reform initiatives − including
Accountable Care Organization development and implementation and care coordination for population health − and creates
business and clinical efficiencies. Services
ranging from supply chain to select IT infrastructure to clinical protocols will be available by the new company to its member
institutions.
“By joining together in this shared services
company, we are able to take advantage of
the collective talents of all of the members
and have the opportunity to invest more in
the care of our patients,” said David C. Herman, M.D., president and chief executive
officer of Vidant Health.
The new company, which will be named
in the near future, will assist in meeting the
challenges posed by declining Medicare/
Medicaid reimbursement and technological changes while creating a platform for
innovation and enhanced clinical care for
patients.

“These three organizations have joined
resources to more quickly innovate care
models and support infrastructure that reduce cost and best meet the needs of the
diverse patient, consumer and workforce
populations that we serve throughout the
state,” said John D. McConnell, M.D., chief
executive officer, Wake Forest Baptist Medical Center.
All three organizations’ boards have approved moving forward with creating a
shared services organization as a key strategy for improving all of the health systems’
efficiencies and value.
“This new collaborative fits perfectly with
our mission and goals of seeking preferred
partners to deliver an exceptional level of
health care service while leveraging our
structures and technological resources,”
said Donald Gintzig, president and CEO of
WakeMed Health & Hospitals. “We want to
deliver the best value to our state’s citizens
and do so in a cost-effective manner that is
beneficial for all.”

News

Nurses Named to the “Great 100”
across the state. Ms. Pritchett,
along with 99 other registered
nurses, was selected on the
basis of outstanding professional ability and commitment
to improving health care.

Robin Pritchett, R.N., with WakeMed
Health & Hospitals, has been selected as
one of The Great 100 Nurses in North Carolina by The Great 100 Inc., an organization
that recognizes nursing excellence and
provides scholarships to nursing students

20

The Triangle Physician

Pritchett, who wanted to be a
nurse for as long as she can remember, has over 30 years of
experience, including 14 years
at WakeMed. She has spent the past four
years as a staff nurse in WakeMed’s Chest
Pain Unit where she is involved in the staff
unit council and has served on several hospital-wide committees.

Thatâ&#x20AC;&#x2122;s right! Your conservation effort is increased
by a 3-to-1 matching gift. So, when you are one
of the first to display the new North Carolina
Wildlife Habitat Foundation NCDMV license tag,
your $10 tag contribution to the organization
becomes $40 in lands preserved.
The all-volunteer North Carolina Wildlife
fe
Habitat Foundation assists in acquisition,
on,
management, and protection of land
in North Carolina for the conservation
of habitats needed to preserve wildlife

right here in the Old North State. Conservation
education efforts are preparing future
generations to sustain your concern for the lands
we protect today.
At www.ncwhf.org, download the license tag
application
and see the good works in process.
pp
Your new
tag shows your support and your
n
contribution
is put to workâ&#x20AC;Śtimes four.
co

www.ncwhf.org
w

october 2014

21

3D MAMMOGRAPHY
WE’RE TALKING WAY BETTER
IMAGING, EARLIER DETECTION,
FEWER FALSE POSITIVES AND
LESS CHANCE OF A CALL BACK.
END OF DISCUSSION.

3D MAMMOGRAPHY • GREATER ACCURACY • REDUCED ANXIETY • NOW AT WAKE RADIOLOGY
Let’s have a frank discussion. You can’t treat what you can’t detect. And 3D mammography, along with
your regular 2D exam, is revolutionizing breast cancer detection. How? By significantly improving clarity for
earlier detection and fewer false positives. Which, of course, reduces recall rates and the anxiety that comes with
additional tests. To learn more about 3D mammography or to schedule an appointment, visit wakerad.com. Like
we said, you can’t treat what you can’t see. And now we’re seeing better than ever.
Wake Radiology | North Hills Breast Center | 919-232-4700 | wakerad.com
Daily, evening and Saturday appointments | 20 minutes from check-in to exam completion